Department of Pediatrics, Robert Larner, M.D. College of Medicine, University of Vermont, Burlington, Vermont;
Vermont Oxford Network, Burlington, Vermont.
Pediatrics. 2020 Oct;146(Suppl 2):S183-S193. doi: 10.1542/peds.2020-016915J.
Achieving the ambitious reduction in global neonatal mortality targeted in the Sustainable Development Goals and Every Newborn Action Plan will require reducing geographic disparities in newborn deaths through targeted implementation of evidence-based practices. Helping Babies Survive, a suite of educational programs targeting the 3 leading causes of neonatal mortality, has been commonly used to educate providers in evidence-based practices in low-resource settings. Quality improvement (QI) can play a pivotal role in translating this education into improved care. Measurement of key process and outcome indicators, derived from the algorithms ("Action Plans") central to these training programs, can assist health care providers in understanding the baseline quality of their care, identifying gaps, and assessing improvement. Helping Babies Survive has been the focus of QI programs in Kenya, Nepal, Honduras, and Ethiopia, with critical lessons learned regarding the challenge of measurement, necessity of facility-based QI mentorship and multidisciplinary teams, and importance of systemic commitment to improvement in promoting a culture of QI. Complementing education with QI strategies to identify and close remaining gaps in newborn care will be essential to achieving the Sustainable Development Goals and Every Newborn Action Plan targets in the coming decade.
要实现可持续发展目标和每个新生儿行动计划中制定的降低全球新生儿死亡率的宏伟目标,就需要通过有针对性地实施基于证据的实践来减少新生儿死亡的地域差异。“帮助婴儿生存”是一套针对导致新生儿死亡的三个主要原因的教育计划,通常用于在资源有限的环境中教育提供者实施基于证据的实践。质量改进(QI)可以在将这种教育转化为改善护理方面发挥关键作用。衡量源自这些培训计划核心算法(“行动计划”)的关键过程和结果指标,可以帮助医疗保健提供者了解其护理的基本质量,发现差距,并评估改进情况。“帮助婴儿生存”一直是肯尼亚、尼泊尔、洪都拉斯和埃塞俄比亚质量改进计划的重点,在衡量挑战、基于设施的质量改进指导和多学科团队的必要性以及系统承诺对促进质量改进文化的重要性方面,都取得了重要的经验教训。在未来十年内,要实现可持续发展目标和每个新生儿行动计划的目标,就必须将质量改进策略与教育相结合,以发现和弥补新生儿护理方面尚存的差距。